15720 POST THIS CARDNTA'R FRONT OF,BUILDING PERMIT NUM BER
CITY OF CUPERTINO 15T2�
INSPECTION�DIVISION
.' JOB INSPECTION RECORD
Al -PERMIT EXPIRATION
JOB ADDRESS /O/OU /V h1dZ"CEfJ UNIT# _LOT#
n�l PERMIT EXPIRES IF.WORK',
owrvER - �!--��7/tv-v/L OU'T(9.tJ CONTRACTOR pev��/SiJ (,.,q-' ro-//Z. G>..a•' IS. NOT STARTED NiTHINi.
.
INSPECTION DATE I INSPECTOR INSPECTION RECORD180 DA, S OF PERMIT ISSU-
FOUNDATIbN - - ANCE OR'180 DAYS FROM,
NOTE: LASTCALLED INSPECTION. +
UFER + ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF • PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS - ,: ' "o
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1.
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - I ISSUANCE DATE
MECHANICAL - BLDG. ELECT. PLC. MECH
-El
o ' o..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
' •WOOD'FLOOR INFORMATION
VALUATION "$/FT.
PLUMBING
'.MECHANICAL
ELECTRICAL - -
PERMIT TO
FRAMING
.INSULATIONS - _ - sroRiEs TYPE CONSTR
OCC,GROUP ,'PDSVNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SG.UT�FLOORANEA TOTALACREACE I
-• ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE I
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
auaomusE
- ' ROOF SHEATHING � .' � � .Es IND CONNPB ,on,...f
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' ED El ',❑ ❑ ❑
ASSESSOR SPA.CE L NO.
ROUGH SAN.p
PLUMBING - ELECT:ENERGY - �•
. `
' TUBS&SHOWER PAN _ � ' � PLUMBING ENERGY� - - TRACT NO PARCELING.PARCELING.G. '
MECHANICAL • MECH.ENERGY.
ACC.DATE ACC:FILE'NO.
ELECTRICAL . BUILDING ENERGY -
FRAMING ELECT.FINAL TEST' X
ZONING ENG SITE NO
INSULATION - � � -• PLUMBING
GAS TEST - GAS
' - MECHANICAL' FIRE'SPRINK ENERGY.T-2a t
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "❑ [j, NE]
FLOOD ZONE A.L u,c;
EXTERIOR SHEAR ELECTRICAL-RELEASE '
INTERIOR.SHEAR .! FIRE DEPT. - . . Y ❑ N❑ Y 01 N❑.
SHEETROCK _ GRADE 'FEE SUMMARY
EXTERIOR�LATH - BUILDING
INTERIOR LATH - TEMPORARY APPROVALS - BUILDING.
SCRATCH COAT' ELECTRIC - PLAN CHECK
GAS - .FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ;
OCCUPANCY OF BUILDING IS NOTP.ERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
N1ICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, » ELECTRIC
0 ONE WORKING DAY BEFORE REQUIRED INSPECTION '; PLUMBING
Z PLEASE'GIVE JOB ADDRESS WHEN PHONING.
• = SEE PERMIT,', FOR EXPIRATION DATE- " f, MECHANICAL
IMPORTANT! n CONST.TAX
PLEASE READ REVERSE,SIDE BEFORE .TLLLLL,„ KEV I : 'TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
PERMIT NUMBER
" UILDINGPROJECT IDENTIFICATION APPLICATION
uaDlNc , 157-20 .
ADDRESS
QC WOt FE Rp //polo 17,Wp„. kDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S/'• /� - PLAN CHECK VALIDATION
NAME G��--L7iGO�Y/Gn O✓' TI W'G�.
Q tQ,1A! DNE QTY. ELECTRIC PERMIT FEE
NTRACTOR'S
// Np OUTLETS-SWITCHES-RECEP 10.00/1.00
mp / [f/' ,414 LIC.No. LIGHTING FIXTURES 10.00/1.00
ADDRESS TORS PPLIANCES-RESIDENTIAL 4.00
d aCoM"Q W4 PRONE DO PANELS - 10.00 DATE OF APPLICATION
ORRCNITECTTNA�s PANELS (OVER 200 AMP) 20.00 LAN CHECK FEE PP.C.NO..
ENGINEER n_
Ica uc.NO. SIGNS TRANS. 3.00
AARCH OR
DDRESS ENG. .5V/7L- ZD j SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
20 i ,,v/ , zlP O ,EMP,METER OR POLE INS. 20.00 \/�y/y/
APPLICANT'S V V -
ADDRESS n MOTORS SEE FEE SCH.
O T Coi767 Wit NtCo G../T SERVICE CHANGE 20.00 -7
M o LICENSED CONTRACTORS DECLARATION ���
a z w 1 hereby affiNn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a N (commencing with Section 7000)of Division 3 of the Business andi
e 4 BLDG. ELECTPLG. MECH.
I�n
H O z Professions g/�i y license s in full for .fef}3 ❑ ❑ ❑
z oLicense Classs sNumber Y
Nw Date
Contractor
a , s I �� BUILDING PERMIT
rt ¢ OWNER-BUILDER DECLARATION
a o i U INFORMATION
w ;LL u- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
�n VALUATION $/FT.
F LL O a Law for the following«eson.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city ar county which requiresa permit to construct,alter,
Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
wgo O LL requires the applicant for such permit to file a Signed statement that TOTAL PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
r z i' Law(Chapter 9(commencing with Sect on 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
T =$ the basis for the aIle ed exem lion.An
g p he."'lionof it invin703L5 STORIES TYPE CONSTR.
i ; _ by any applicant for aoold'eSubjects S500).licent toucivilpenultY ALTER-DRAIN -WATER (EA.) 5.00
of not more than five Imndred Aollars(5500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the Structure is not
intended or offered for sale (Sec. 7044, Business.,of Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE
himselfor through his own employees,provided that such improve- ,
marts are not intended or offered for sale.If,however,the building ' GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose of sola). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Oona,
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ - ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:I he Contractor's License Law does not apply _
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.Ra this WATER HEATER W/VENT 6.00
reason
Doom r.�R DL-r»�.ryraN ' WATER SYSTEM 5,66 ACC.DATE ACC,FILE NO.
W;06RRKERRS`'FC_O`MPPENS^A-T_ION D9 ECCLLAARATION WATER TREATING EQUIP. 5.00
I hereby nffum that I have m
a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Copensation Insumnm,or a certified
copy thereof(Sce.3800,mLa b.C.)
' A
. CopanylCYY 4 Vf/A41VC46
0 ❑ Cetlifiedcopylsherebyl'urnislled. FIRESPRINK ENERGY T$4
Z p Phcent if copy is Filed with the city inspection division. MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ -
P2 -/ -�ttA'lhzl+V�- PERMIT ISSUANCE FLOOD zorvE - AL.u.c.
Cr CERTIFICATE OF EXEMPTION FROM WORKERS'
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 9a Y❑ N❑ Y C] Nr]
Z (This section need not be completed if the permit is for one - TOTAL 7
hundred dollars(4100)pe less.) FEE SUMMARY
U O 1 certify that h the performance of then in for which this per. Q MECHANICAL PERMIT J FE
Lt.0 F mil is issued,e I shall not employ any person in any manner so h
OW become subject to the Workers'Compensation Laws of Ca fi
BUILDING -
Date Applicant ALTER OR ADD TO MECH.
} tail NOTICE TO APPLICANT: If,after making this Certificate or Ex.
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ,
Provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A000.F.M.) A:%
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.FM.) 6.00 SEISMIC FEE
I hereby,affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
3097.performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
ener's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.88 t-f-
• information is correct. I agree to comply with all city and county BOILER H.P.or 100,0008.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building,construction, and CT
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEEFEESCH. MECHANICAL 7 xl
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD..
uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE -40:06 o CONST.TAX:
ay in any way acerae against said City in consequence of the
ranx ffix er
II MECH.CONT. LIC.NO. MECH.
NOTALa 7 S p, TOTAL
Signature of Applicant/Contactor Data '
OFFICE COPY